how much will nationalized healthcare cost the country?

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MEMORANDUM<o:p></o:p>
<o:p> </o:p>
TO: HOUSE REPUBLICANS AND OTHER INTERESTED PARTIES<o:p></o:p>
FROM: REP. PAUL RYAN<o:p></o:p>
DATE: JUNE 24, 2009<o:p></o:p>
<o:p> </o:p>
A STRATEGY TO STOP GOVERNMENT-RUN HEALTH CARE AND IMPROVE <st1:place w:st="on"><st1:country-region w:st="on">AMERICA</st1:country-region></st1:place>’S HEALTH CARE SYSTEM<o:p></o:p>
<o:p> </o:p>
---<o:p></o:p>
<o:p> </o:p>
Summary<o:p></o:p>
<o:p> </o:p>
The Administration and the Democratic Majority in Congress are mounting an all-out rush to force a government-run health care measure through Congress without anything close to the robust public scrutiny and debate such a radical and untested new entitlement program requires. The Majority’s rush to judgment may be politically expedient, but it is extremely irresponsible, unwise, and unfair to the people of this country.<o:p></o:p>
<o:p> </o:p>
With a united strategy, we Republicans have it in our power to expose the irreversible consequences of this reckless course. We can go to the nation, explain what is happening, and engage the American people in a serious, timely, and comprehensive discussion about health care and the alternative choices before them. No other issue before Congress is as urgent as this. All of us together, beginning now, must focus the nation’s undivided attention on this issue.<o:p></o:p>
<o:p> </o:p>
This memo’s purpose is to describe the health care debate in ways that most Americans can understand and to offer a united strategy for addressing it.<o:p></o:p>
<o:p> </o:p>
---<o:p></o:p>
<o:p> </o:p>
Introduction<o:p></o:p>
<o:p> </o:p>
We have reached a crucial moment, and perhaps a historical tipping point, on health care specifically and free market democracy more broadly. The next few months are likely to define the fight for limited government and free market economics for many years to come. The debate over government-controlled health care is critical to the future of Americans’ health, <st1:place w:st="on"><st1:country-region w:st="on">America</st1:country-region></st1:place>’s prosperity, and American vitality, but the American people are being denied the opportunity to consider and to understand its implications. <o:p></o:p>
<o:p> </o:p>
The Administration and the Democratic Majority in Congress are mounting an all-out rush to force a government-run health care measure through Congress without anything close to the robust public scrutiny and debate such a radical and untested new entitlement program requires. The Majority’s rush to judgment may be politically expedient, but it is extremely irresponsible, unwise, and unfair to the people of this country.<o:p></o:p>
<o:p> </o:p>
This strategy is also self-contradictory: if the Democrats believe their plan will establish a sweeping and comprehensive transformation of the way our nation provides for our people’s health care, why would they deny Americans sufficient time for careful examination, thorough deliberation, and responsible public discussion of the details of their proposal? Why the rush to judgment of an untested experiment with our nation’s health?<o:p></o:p>
<o:p> </o:p>
With a united strategy, we Republicans have it in our power to demand that this reckless course be stopped. We can go to the nation, explain what is happening, and engage the American people in a serious, timely, and comprehensive discussion about health care and the consequences of the alternative choices before them. No other issue before Congress is as urgent as this. All of us together, beginning now, must focus the nation’s undivided attention on this issue. This memo’s purpose is to describe the health care debate in ways that most Americans can understand and to offer a united strategy for addressing it.<o:p></o:p>
<o:p> </o:p>
The American public is being presented with a false choice between accepting a government takeover of health care or doing nothing. But there is a third way – a patient-centered reform model – which we Republicans must advocate with one voice, clearly and effectively. For too long Republicans have been timid when talking about health care. This has been a huge mistake on our part. We have creative, excellent, and timely ideas on how to improve health care; this is an issue that, like welfare reform and fighting crime in decades past, we should come to own. <o:p></o:p>
<o:p> </o:p>
As the Democrats’ legislation is gradually revealed, Republicans must frame the debate candidly and clearly, and we must win this debate. To win this debate, Republicans must demonstrate four essential points:<o:p></o:p>
<o:p> </o:p>

  • The Democratic plan is outrageously expensive and fiscally irresponsible: it will fail to control health care costs, will exacerbate our growing debt, and will require crushing taxes: Their approach would spend trillions more dollars, mandate that employers provide health insurance, impose a massive new tax burden on employers and heath care practitioners, and make our entitlement crisis worse by adding another open-ended entitlement;

    <o:p></o:p>
  • The Democratic plan would undermine the quality of American health care, displace those who are happy with their coverage, require painful rationing of care, and insert the government between doctors and patients: This would constrain the freedom of medical providers, limit patient options, and restrict the right of patients to make personal health care decisions in consultation with their doctor;

    <o:p></o:p>
  • The Democratic plan would vastly expand the reach of government into the private lives of American citizens and increase individual dependence on the state: It would have us trade individual liberty for the false promise of health security, and rather than having the federal government help to expand opportunities for you, their plan would provide more direct benefits and establish more boundaries and rules. This bureaucratization of American life stifles the energy and ingenuity that make our country great.

    <o:p></o:p>
  • Republicans have a better approach: Republicans do not deny the severity of the problem of health care costs, but we know that any solution must respect doctor and patient privacy, must restrain spending and not increase it, and must use the energy of our free market system rather than drain it. We have just a solution—one focused on the real problems in health care financing, rather than driven by an ideological desire to expand the government. <o:p></o:p>
<o:p> </o:p>
I. Government-Driven Health Care Less “Inevitable” Today Than In 1993 With The <st1:place w:st="on"><st1:city w:st="on">Clinton</st1:city></st1:place> Plan<o:p></o:p>
<o:p> </o:p>
The Clinton Administration in 1993 pushed hard for Congress to enact a government-run health care plan. At first, enactment seemed all but inevitable. Yet within a few months, a strong and united Republican response together with growing popular doubts about the quality and cost of government health care stalled and defeated it, causing a popular backlash later symbolized by <st1:city w:st="on"><st1:place w:st="on">Clinton</st1:place></st1:city>’s statement that “the era of big government is over.” That experience showed that Republicans must not accept the claim that government health care is “inevitable.” If we work to bring about real reform and real results – if we tirelessly point out the flaws of government-run health care and tirelessly offer better alternatives – it can be prevented again.<o:p></o:p>
<o:p> </o:p>
Since the <st1:city w:st="on"><st1:place w:st="on">Clintons</st1:place></st1:city>’ plan was defeated, two things have happened:<o:p></o:p>
<o:p> </o:p>
First, health care itself has had great successes in the development of new technologies and treatments for many illnesses, helping Americans live longer and healthier lives than ever. In fact, an overwhelming amount of survey data shows that about 80 percent of Americans say they are satisfied with the quality of their health care and about 75 percent are happy with their current health care coverage.<o:p></o:p>
<o:p> </o:p>
Second, however, a clear public consensus has grown that the delivery of health care services has become too costly and inaccessible to millions of households. Our people and government are together spending larger shares of their limited resources on health care than ever before. There are distortions in our system of health care delivery that must be addressed.<o:p></o:p>
<o:p> </o:p>
The Majority in Congress has not leveled with the American people about the real nature of their health care plan. And there is hard evidence that the radical transformation of the nation’s health care system which they are planning behind closed doors is politically vulnerable. A recent Pew Research poll compares the public’s appetite for a government-driven overhaul in 1993 and today, and it provides conclusions that should strengthen our resolve on this issue. Since the failed 1993 effort, the Pew poll finds that Americans today are less supportive of the idea our health care system needs to be “completely rebuilt”, more favorable to making “only minor changes”, and increasingly concerned with limiting costs relative to expanding access. Nowhere is there much endorsement of anything close to the extreme vision Democrats are pursuing so intently.<o:p></o:p>
<o:p> </o:p>
Echoing the Pew data, Democratic pollster Stanley Greenberg recently found in his own research that on question after question the appetite for a radical health care agenda has waned since the 1993 failure. In a piece written in The New Republic, Greenberg laments that “the desire for change and support for reform was slightly stronger 16 years ago".<o:p></o:p>
<o:p> </o:p>
The latest talking points from Democrats reflect the need to conceal their policies behind poll-friendly, basically Republican rhetoric. For example, they complain about the growing cost of entitlement spending, namely Medicare and Medicaid, and yet their solution is to create a new open-ended health entitlement. They claim to want more competition to keep private health insurers honest, but they propose a government insurance entity that would crowd out and ultimately replace the private insurance market. They speak Republican language about “investments” and “incentives,” but their government-run program would replace incentives with directives and private investment with taxpayer subsidies. They disavow any plan for “socialized medicine,” but the Majority’s proposal would smother private providers leaving the government to monopolize the entire health care field, “socialist” in all but name and by any reasonable definition.<o:p></o:p>
<o:p> </o:p>
Cognizant of Pew’s findings that a majority of Americans disagree with the assertion that health care in <st1:country-region w:st="on"><st1:place w:st="on">America</st1:place></st1:country-region> needs to be “completely rebuilt,” the President and Congressional leaders emphasize instead that they simply want to build upon “what works” in our current system. Heeding Greenberg’s conclusion that “three-quarters of Americans are satisfied with their own health insurance,” those pushing a plan that would force millions to be dumped onto government insurance echo the false refrain: “If you like what you got, you can keep it.” Nonpartisan studies from the CBO and independent actuarial firms refute these claims, presenting an unpleasant truth that is slowly creeping into the national debate. As a recent Associated Press story noted: “White House officials suggest the President's rhetoric shouldn't be taken literally.”<o:p></o:p>
<o:p> </o:p>
As the gap between substance and rhetoric widens, more and more news accounts and commentary are saying that the success of the health care crusade “suddenly appears in real jeopardy”. We Republicans are being presented with a critical opportunity. Encouraging data and a shift in popular perception should embolden our cause. Republicans must step up to grasp this opportunity and meet the challenge.<o:p></o:p>
<o:p> </o:p>
II. New Costs And New Taxes In The Democratic Proposals<o:p></o:p>
<o:p> </o:p>
Without an open debate or even a specific bill, no one knows exactly how costly the Democratic health care proposal will be. Some estimates have been made, however, and the President himself has made proposals that we should understand carefully.<o:p></o:p>
<o:p> </o:p>
- Early estimates from the CBO indicate that Democratic health care proposals will cost more than 1 trillion dollars over ten years. Private firms are estimating those numbers could rise to 4 trillion once all program expansions for Medicare and Medicaid are taken into account.<o:p></o:p>
<o:p> </o:p>
- $600 billion of this cost are supposed to come from a combination of Medicare provider cuts and some $300 billion in income tax hikes in upper tax brackets.<o:p></o:p>
<o:p> </o:p>
- President Obama recently proposed an additional $313 billion in Medicare and Medicaid provider cuts over ten years, including:<o:p></o:p>
<o:p> </o:p>
<o:p> </o:p>
o Cuts in payments to providers to reflect “efficiencies” supposed to save $110 billion over the next decade. Basically, this is bureaucratic speak for cutting doctors’ and hospitals’ reimbursement rates.<o:p></o:p>
<o:p> </o:p>
o Cuts in federal subsidies to hospitals that treat large populations of uninsured patients, justified by the assumption that everyone will be insured now. This is estimated to save $106 billion over ten years.<o:p></o:p>
<o:p> </o:p>
o Cuts in federal payments to pharmaceutical companies to provide prescription drugs to seniors and others, saving $75 billion over the next decade. These cuts are in effect price controls on the Medicare Part D prescription drug program.<o:p></o:p>
<o:p> </o:p>
- A portion of the bill now being written in the Senate Health, Education, Labor, and Pensions Committee is being estimated to cost about $1 trillion. But CBO has not yet scored three major pieces (government option, employer mandate, and Medicaid expansion) that will drive the cost far higher. The nonpartisan Lewin Group, mentioned above, estimates the Medicaid expansion portion (a 50% enrollment increase to cover 60 million people, or one in five Americans) would cost nearly $911 billion over a decade. HSI Network, another private research group, has estimated this Senate Committee bill at $4 trillion for the same time period.<o:p></o:p>
<o:p> </o:p>
- The Senate Finance Committee is working on several tax increases, including:<o:p></o:p>
<o:p> </o:p>
o A tax on employer-provided health benefits (and so on most working Americans) to generate anywhere from $100 billion to $400 billion over 10 years.<o:p></o:p>
<o:p> </o:p>
o A 10-cent tax on sugary drinks ($110 billion), an increase in the alcohol tax ($61.5 billion), a 2% surtax on wealthier taxpayers, and a 0.375% increase in the Medicare portion of the payroll tax paid by all workers ($600 billion).<o:p></o:p>
<o:p> </o:p>
o Eliminating deductions for pharmaceutical advertising ($37.5 billion).<o:p></o:p>
<o:p> </o:p>
- The House Democrats’ proposals are even more secretive, but they are reported to be planning $600 billion in Medicare cuts and $600 billion in tax hikes, such as higher payroll taxes or a new VAT tax. The proposed 8% “pay-or-play” tax on workers would push <st1:country-region w:st="on"><st1:place w:st="on">America</st1:place></st1:country-region>’s payroll tax rate to 23%. For those who chose not to buy health insurance, they will be hit with an across the board 2% tax on Adjusted Gross Income.<o:p></o:p>
<o:p> </o:p>
The fiscal features of the Majority’s plans dodge the two basic problems at the heart of this issue. First, not a single dollar of any Medicare/Medicaid savings they claim to make is used to reduce deficit spending. Second, their so-called “offsets” do nothing to remove the government-driven market distortions (such as obsolete tax exclusions and Medicare/Medicaid payment structures) that are causing our health care delivery issues. Democrats argue—following these figures—that they “offset” the trillion-plus dollar cost of universal health care with a combination of tax increases and coverage cuts in other health care areas. Robbing Peter to pay Paul while taxing them both is not what <st1:place w:st="on"><st1:country-region w:st="on">America</st1:country-region></st1:place> needs for better health care delivery.<o:p></o:p>
<o:p> </o:p>
The high cost of coverage and care is the fundamental problem at the core of health care dilemmas. The mounting deficits and debt are the fundamental problems at the heart of our larger national fiscal crisis. The Democrats’ plans would make both problems significantly worse.<o:p></o:p>
<o:p> </o:p>
<o:p> </o:p>
III. How The Democrats’ “Public Option” Eliminates Choices And Undermines Quality<o:p></o:p>
<o:p> </o:p>
The Majority’s proposal for a “public option” in health insurance is a back-door plan to replace health care based on patient choice and market competition with bureaucratized medicine—not all at once but step by step. Their misuse of Republican language, their nervous ridicule of talk about “socialized medicine,” together with the gradualism of their plan demonstrate that they know the American people would repudiate openly admitted socialized medicine.<o:p></o:p>
<o:p> </o:p>
The most urgent Republican task is to explain to Americans that under this new health care entitlement, the federal government would serve as both referee and player in the same game, creating a predetermined outcome whereby more and more families lose the coverage they now have and are forced into government-run insurance.<o:p></o:p>
<o:p> </o:p>
How drastic would the loss of coverage be? One nonpartisan study by the Lewin Group estimated that nearly 120 million Americans would lose their private health insurance under health reforms proposed by the candidates in last year’s Democratic presidential primary campaign. More recently, the CBO stated that an estimated 23 million Americans would no longer be covered under the proposal coming from the Senate Health, Education, Labor, and Pensions Committee. As these studies indicate, a “public option” plan cannot be put alongside existing private alternative options without forcing millions of Americans out of the health plan they prefer and into the government insurance option, which will become a government insurance monopoly.<o:p></o:p>
<o:p> </o:p>
Here is how it works: the federal government “option” would pay doctors at below market prices in order to “control costs.” When the government short-changes doctors, the rest of us will be forced to make up the difference: those not on the government plan will have to pay more for the same care. If the government plan will only pay $50 to your doctor for a procedure that costs $100, then your doctor will be forced to charge you $150 for the same procedure to make up the difference. With costs continuing to mount, employers will increasingly find it more cost-effective to drop private coverage altogether and dump their employees into the government plan. The President has yet to reconcile the fact that millions will be forced into the government option with his vague promise that “if you like what you got, you can keep it.”<o:p></o:p>
<o:p> </o:p>
As more people find themselves forced into the government plan, the only way to contain costs will be through rationing. The decision as to whether or not you get a hip replaced will not be a decision you or your doctor will make, it is a decision your government will make. The Majority in Congress has already set up the bureaucratic institution to make these rationing decisions; they simply need the government insurance plan to seal the deal.<o:p></o:p>
<o:p> </o:p>
A government monopoly of health care will have serious consequences. It will:<o:p></o:p>
- Eliminate patient choice,<o:p></o:p>
- Ration access to care, most painfully for society’s most vulnerable, and <o:p></o:p>
- Reduce incentives for robust medical research and for talented people to choose careers in health care.<o:p></o:p>
<o:p> </o:p>
Even if the formal “public plan” is stripped from the Democrats’ bill, they would still pursue these ends by the combination of regulations and mandates that would remain. The “public option” is not the core of the problem with their approach: government control of health insurance is the core of the problem. <o:p></o:p>
<o:p> </o:p>
IV. What Republicans Must Avoid<o:p></o:p>
<o:p> </o:p>
It is important for Republicans to resist the temptation to narrow the health care debate to focus exclusively on relative cost-benefit analyses. Of course it is true and essential to show the excessive price for the Majority’s plan, and this will be an important part of our argument. But if the Republicans’ only response smacks of accounting objections to helping people when popular concern about access to health care is growing, all the number crunching in the world will not be persuasive.<o:p></o:p>
<o:p> </o:p>
In addition, if the only objection we have is about dollars, Democrats will easily find some cost-reducing “compromise” to buy Republican support and give us short-term emotional satisfaction in sharing “bipartisan credit.” But any such compromise will still result in the long-term victory of government-monopolized health care. Whether the initial version enacted is modest or comprehensive, any option that includes government-provided services will:<o:p></o:p>
- undermine <st1:country-region w:st="on"><st1:place w:st="on">US</st1:place></st1:country-region> health care delivery in the long term,<o:p></o:p>
- prove impossible to reverse, and<o:p></o:p>
- accelerate us toward a tipping point on the question of the role of government.<o:p></o:p>
<o:p> </o:p>
V. Why Republicans Are Offering Real Alternative Reforms<o:p></o:p>
<o:p> </o:p>
Republicans cannot win this debate only by opposing Democratic proposals. We must also promote real reforms that address the growing problems that concern Americans about the delivery of health care services. Because Republicans have a solid commitment to the moral case for free market democracy, we are in a strong position to bring forward better ideas and proposals that can fix the real problems in the delivery of health care without sacrificing principles.<o:p></o:p>
<o:p> </o:p>
Republicans have already offered, or are working on, a number of thoughtful alternative solutions consistent with our principles and effective in practice, removing government-driven market distortions to increase the availability of health care. Senators Tom Coburn and Richard Burr, Rep. Devin Nunes, and I have coauthored one proposal we named the Patients’ Choice Act of 2009. This bill is by no means the last word in reform alternatives, but we take pride in having proposed it long before any actual plan had been offered by the Majority. This bill demonstrates the commitment of Republicans to address serious health care delivery issues with solutions based on freedom, competition, and patients’ choice. Led by Reps. Roy Blunt, Dave Camp, Joe Barton, and others, the House Republican Health Care Solutions Working Group recently unveiled a comprehensive health care alternative grounded on these same principles. Other House Republicans – from Rep. John Shadegg’s interstate shopping proposal to Rep. Mark Kirk’s Medical Rights and Reform Act – continue to demonstrate policy entrepreneurship, and have made clear we are committed to advancing substantive reforms. Republican proposals show that many more uninsured Americans can be covered by spending current dollars more wisely and efficiently, rather than by spending additional billions as the Democrats propose. With multiple alternative proposals in hand, we Republicans hold the high ground, and we should demand that the Democratic Majority tell the American people why they reject free market democratic solutions that respect the decisions and choices of the individuals receiving and paying for health care.<o:p></o:p>
<o:p> </o:p>
Republican policies reflect an approach to the problems of our society which is solidly anchored in timeless principles accepted by a consensus of Americans, combining a moral commitment to beliefs about right and wrong with a commitment to economic well-being. Americans look to ideals such as personal freedom, equal natural rights and opportunity, and government by popular consent as guides to practical solutions that secure the interests of all. <st1:country-region w:st="on"><st1:place w:st="on">America</st1:place></st1:country-region> long ago adopted this “practical idealism” in the form of free market democracy.<o:p></o:p>
<o:p> </o:p>
Sadly, Democrats have abandoned Americans’ practical idealism, instead pushing their nationalized health program by manipulating guilt and provoking envy. The Republican response must appeal to the economic and moral norms of free market democracy which honor and expand consumer choice and producer competition, regulated to enforce honesty, transparency, and fair play. Beyond doubt, free market democracy is still the most successful means yet discovered to improve the well-being and prosperity of individuals and society.<o:p></o:p>
<o:p> </o:p>
When free markets apparently are failing to satisfy the needs of consumers and dissatisfaction grows—as in the provision of health care services—Washington typically misdiagnoses the problem by rushing to blame competition and economic freedom. Often the real cause, though, is the unintended consequences of government-driven interventions in the free market shrinking the provision of services to a few oversized entities. Republicans do not believe that the answer to bureaucratic red tape, gate keeping, and rising costs is to replace them with a single bureaucratic provider armed with the power to stifle its competitors. This is the Majority’s health care plan in a nutshell. The Republican response is to refocus on expanding the supply of health care producers and consumer-driven choices, which we believe is the superior means to achieving universal access to affordable, quality health care.<o:p></o:p>
<o:p> </o:p>
The delivery of health care services is one of the nation’s highest priorities, and it should be. Far from justifying a government takeover of health care which will drive up needless demands for services, the overwhelming importance of this priority is exactly why the health care delivery system must be reformed to increase patient choice, encourage market-based competition for health services, bring down health costs, and increase the supply of health insurance. In any fair debate between government-centered health care where medical decisions are made by bureaucrats versus patient choice empowered by free market competition among health providers, the practical idealism of the American people will prefer individual choice and market freedom.<o:p></o:p>
<o:p> </o:p>
VI. Health Care Providers Must Engage Actively In This Debate<o:p></o:p>
<o:p> </o:p>
Every provider of health-related services – including physicians and nurses, assistants, hospitals and clinics – will be profoundly affected by the outcome of the debate taking place inside the Beltway. Either health care will travel down the path taken by most European countries, <st1:country-region w:st="on"><st1:place w:st="on">Canada</st1:place></st1:country-region>, and other nations with socialized medicine, or it will be reformed to enable practitioners to return to the pursuit of health care excellence. Countries that have chosen nationalized health services have eradicated individual competition and stunted innovation. They have done this by eliminating the incentives to outperform since medical professionals become salaried government workers without adequate rewards for exceeding average standards. Government-driven health care poses at least three major threats to providers.<o:p></o:p>
<o:p> </o:p>
First: The practice of every aspect of government-monopolized medicine inevitably will be reduced to “cookie cutter” standards. Every health care provider knows that patients’ conditions are not exactly the same, and treatments must be tailored to unique needs. Health care excellence like this is only possible under a vibrant free market and not under “one-size-fits-all” regulations of government-controlled health care.<o:p></o:p>
<o:p> </o:p>
Second: The cost and price structure of nationalized medical services are controlled and distorted by price controls dictated by political demands for low rates of reimbursement. There is no lack of historical experience with price and wage controls and their harmful consequences. The principal result is shrinking supplies of price controlled human and material resources, and thus the necessity of managing the decline. In the health care field, shortages must be rationed by deciding who shall receive and who shall be denied life-saving medicines and essential services. Patients with the greatest needs and groups deemed less worthy of treatment are likely to be the first victims of bureaucratically determined health care rationing.<o:p></o:p>
<o:p> </o:p>
Third: Government-run health services build barriers to the most talented young men and women thinking of a medical career. At the very time when there is a growing need for more talented medical practitioners to care for aging boomers, young people with ability and skill will not take on the long years of education and incur substantial student loans just to become de facto government staffers whose type and place of practice and whose reimbursement rates are dictated by federal agencies.<o:p></o:p>
<o:p> </o:p>
These threats, if they become law, will prove lethal to <st1:country-region w:st="on"><st1:place w:st="on">America</st1:place></st1:country-region>’s health care providers. It means we will be on the path to socialized medicine. It is understandable that the Congressional Majority ridicules the claim that this is their objective, but the “public option” insurance plan which they propose as “an important tool to discipline insurance companies," in the recent words of the President, must lead step-by-step down that road. Mocking a fact does not make it untrue. And all we ask is that Democrats call their plan by its rightful name.<o:p></o:p>
<o:p> </o:p>
Health care providers, whether private insurers, doctors, hospitals, or trade associations must resist the temptation to “cut a deal” that would trade some benefit (some type of medical malpractice reform, for instance) in return for silence or outright support for the Majority’s proposal. That “deal” would only buy a little time after which the competitive health care market will be transformed into a nationalized monopoly under which every provider will lose its independence once government is the single payer for medical services.<o:p></o:p>
<o:p> </o:p>
Every day <st1:country-region w:st="on"><st1:place w:st="on">America</st1:place></st1:country-region>’s health care professionals meet the most critical medical needs of our people with a selfless dedication too often overlooked. They deserve our thanks. And they deserve our understanding that the excellence of care they provide cannot continue under a health care government monopoly. In the struggle between their right to practice and compete under free market democracy versus nationalized health service, <st1:country-region w:st="on"><st1:place w:st="on">America</st1:place></st1:country-region>’s dedicated health care providers must not stand to one side. Providers must engage in this struggle for the future of their high profession and commitment to the wellness of the American people.<o:p></o:p>
<o:p> </o:p>
VII. What Is Really At Stake In This Debate?<o:p></o:p>
European Social Welfare State or American Free Market Democracy<o:p></o:p>
<o:p> </o:p>
As important as this debate over the future of health care is, the ramifications go beyond simply health care. This debate may well prove to be a surrogate for the defining issue of our generation: The nature of democratic self-government and whether this great American experiment in individual freedom will be cast aside as inadequate to today’s concerns.<o:p></o:p>
<o:p> </o:p>
If this sounds hyperbolic, consider: <st1:country-region w:st="on"><st1:place w:st="on">America</st1:place></st1:country-region>’s private and public sector already spend about $2.5 trillion a year on health care, more than twice what any other country spends per person, amounting to some 17 percent of our nation’s GDP. If government is now to take over the whole cost burden as another entitlement, the transformation of our society into a European-style social welfare state will be unstoppable. This democratic system under which each citizen takes active responsibility for working to fulfill his or her potential, maturely judging risks and rewards, will be replaced by a nation of passive subjects grateful to government leaders for anything they receive to satisfy their needs, desires, and dreams.<o:p></o:p>
<o:p> </o:p>
The Democratic health care program is a means to a larger end. If President Obama and his party truly want “more competition,” as they say, why propose government insurance instead of enabling more non-profit insurance? If they have no intention of transforming the system into Medicare for all, why do they tie all payments to Medicare? If they have no design to ration health care, why did they tuck in the stimulus package’s fine print a new Institute for Comparative Effectiveness similar to <st1:country-region w:st="on">Britain</st1:country-region>’s National Institute for Health and Clinical Excellence (NICE), which interferes in health technology development in order to lower costs under <st1:country-region w:st="on"><st1:place w:st="on">Britain</st1:place></st1:country-region>’s nationalized health service? This Institute’s stated purpose is to identify medical practices that produce outcomes that “work” as opposed to those that “don’t work.” But under a national health care insurance plan, just as we see in Medicare even now, providers will not be paid out of the plan for health care which the Institute disapproves of. Once competing plans have been driven out of business, the result will be that the government’s approval or disapproval alone will dictate the care providers may offer to beneficiaries. Without any other resource for heath care payments, government decisions through the Institute about “what works” and “what does not work” will automatically result in denying procedures or treatments for certain categories of patients.<o:p></o:p>
<o:p> </o:p>
Finally, if the Majority is so worried about our skyrocketing national debt and the burden on the next generation, why do they want to create an entirely new entitlement that would deal a staggering blow to our economy – an entitlement that rivals the size and liabilities of Medicare?<o:p></o:p>
<o:p> </o:p>
Perhaps because this is ultimately not about health care but about advancing a larger, and I believe pernicious, ideological crusade. The nation that was founded on the belief that our unalienable rights were granted to us not by government but by “nature and nature’s God” will be remade into a “benevolent” social welfare state. Government-run health care is the first step down that path.<o:p></o:p>
<o:p> </o:p>
Compare the Canadian health care system, which liberals often point to as a model for the <st1:country-region w:st="on"><st1:place w:st="on">U.S.</st1:place></st1:country-region> The government is the single payer for health service, though most providers are in the private sector. In <st1:country-region w:st="on"><st1:place w:st="on">Canada</st1:place></st1:country-region> the waiting list is up to more than 4 months between patient referrals and actual treatment for a dozen of the specialty procedures most needed. The average Canadian now has to wait over a month after getting a primary doctor’s instruction just to get a CT scan, and more than two months for an MRI. <st1:country-region w:st="on"><st1:place w:st="on">Canada</st1:place></st1:country-region>’s medical equipment is old, unreliable, and obsolete. Canadians, famous and not so famous, travel to the <st1:country-region w:st="on"><st1:place w:st="on">U.S.</st1:place></st1:country-region> if they can for treatments for everything from cancers and emergency care to hip surgery and childbirth. <st1:country-region w:st="on">Canada</st1:country-region> has long suffered a professional “brain drain,” its doctors fleeing the government-run health care program to practice in the <st1:country-region w:st="on"><st1:place w:st="on">U.S.</st1:place></st1:country-region> The U.S. Government tried to make this more difficult, yet according to a 2007 report, one in nine doctors trained in <st1:country-region w:st="on"><st1:place w:st="on">Canada</st1:place></st1:country-region> is now practicing medicine here. But where will Americans, whether uncared-for patients or government medical workers, go to when the <st1:country-region w:st="on"><st1:place w:st="on">U.S.</st1:place></st1:country-region> also has socialized health care? There is no place of freedom left. Either we keep free market democracy here, or it will enter the history books as civilization’s great but unsuccessful experiment in human liberty.<o:p></o:p>
<o:p> </o:p>
It falls to Republicans to prevent that from happening. It rests with us to keep <st1:country-region w:st="on"><st1:place w:st="on">America</st1:place></st1:country-region> on the path of free markets, which has served us so well in the past, which has lifted countless people out of poverty, and which can lead Americans to a healthier and more prosperous future. This is the moment in which we need to step up and be counted, in which we fight for the principles on which this nation was founded and to which it must remain committed. The stakes could hardly be higher.<o:p></o:p>
<o:p> </o:p>
Our members should concentrate all of our attention on getting this message out to our constituents and the entire country, using all the means from speeches and letters to the many new media formats available to do this.<o:p></o:p>
<o:p> </o:p>
###<o:p></o:p>

To learn more about The Patients’ Choice Act of 2009: http://www.house.gov/ryan/PCA <o:p></o:p>
For the latest from Paul Ryan: http://twitter.com/reppaulryan | http://www.facebook.com/reppaulryan | http://www.youtube.com/reppaulryan | http://www.house.gov/ryan <o:p></o:p>
 

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MEMORANDUM<o:p></o:p>
<o:p> </o:p>
TO: HOUSE REPUBLICANS AND OTHER INTERESTED PARTIES<o:p></o:p>
FROM: REP. PAUL RYAN<o:p></o:p>
DATE: JUNE 24, 2009<o:p></o:p>
<o:p> </o:p>
A STRATEGY TO STOP GOVERNMENT-RUN HEALTH CARE AND IMPROVE <st1:place w:st="on"><st1:country-region w:st="on">AMERICA</st1:country-region></st1:place>’S HEALTH CARE SYSTEM<o:p></o:p>
<o:p> </o:p>
---<o:p></o:p>
<o:p> </o:p>
Summary<o:p></o:p>
<o:p> </o:p>
The Administration and the Democratic Majority in Congress are mounting an all-out rush to force a government-run health care measure through Congress without anything close to the robust public scrutiny and debate such a radical and untested new entitlement program requires. The Majority’s rush to judgment may be politically expedient, but it is extremely irresponsible, unwise, and unfair to the people of this country.<o:p></o:p>
<o:p> </o:p>
With a united strategy, we Republicans have it in our power to expose the irreversible consequences of this reckless course. We can go to the nation, explain what is happening, and engage the American people in a serious, timely, and comprehensive discussion about health care and the alternative choices before them. No other issue before Congress is as urgent as this. All of us together, beginning now, must focus the nation’s undivided attention on this issue.<o:p></o:p>
<o:p> </o:p>
This memo’s purpose is to describe the health care debate in ways that most Americans can understand and to offer a united strategy for addressing it.<o:p></o:p>
<o:p> </o:p>
---<o:p></o:p>
<o:p> </o:p>
Introduction<o:p></o:p>
<o:p> </o:p>
We have reached a crucial moment, and perhaps a historical tipping point, on health care specifically and free market democracy more broadly. The next few months are likely to define the fight for limited government and free market economics for many years to come. The debate over government-controlled health care is critical to the future of Americans’ health, <st1:place w:st="on"><st1:country-region w:st="on">America</st1:country-region></st1:place>’s prosperity, and American vitality, but the American people are being denied the opportunity to consider and to understand its implications. <o:p></o:p>
<o:p> </o:p>
The Administration and the Democratic Majority in Congress are mounting an all-out rush to force a government-run health care measure through Congress without anything close to the robust public scrutiny and debate such a radical and untested new entitlement program requires. The Majority’s rush to judgment may be politically expedient, but it is extremely irresponsible, unwise, and unfair to the people of this country.<o:p></o:p>
<o:p> </o:p>
This strategy is also self-contradictory: if the Democrats believe their plan will establish a sweeping and comprehensive transformation of the way our nation provides for our people’s health care, why would they deny Americans sufficient time for careful examination, thorough deliberation, and responsible public discussion of the details of their proposal? Why the rush to judgment of an untested experiment with our nation’s health?<o:p></o:p>
<o:p> </o:p>
With a united strategy, we Republicans have it in our power to demand that this reckless course be stopped. We can go to the nation, explain what is happening, and engage the American people in a serious, timely, and comprehensive discussion about health care and the consequences of the alternative choices before them. No other issue before Congress is as urgent as this. All of us together, beginning now, must focus the nation’s undivided attention on this issue. This memo’s purpose is to describe the health care debate in ways that most Americans can understand and to offer a united strategy for addressing it.<o:p></o:p>
<o:p> </o:p>
The American public is being presented with a false choice between accepting a government takeover of health care or doing nothing. But there is a third way – a patient-centered reform model – which we Republicans must advocate with one voice, clearly and effectively. For too long Republicans have been timid when talking about health care. This has been a huge mistake on our part. We have creative, excellent, and timely ideas on how to improve health care; this is an issue that, like welfare reform and fighting crime in decades past, we should come to own. <o:p></o:p>
<o:p> </o:p>
As the Democrats’ legislation is gradually revealed, Republicans must frame the debate candidly and clearly, and we must win this debate. To win this debate, Republicans must demonstrate four essential points:<o:p></o:p>
<o:p> </o:p>

  • The Democratic plan is outrageously expensive and fiscally irresponsible: it will fail to control health care costs, will exacerbate our growing debt, and will require crushing taxes: Their approach would spend trillions more dollars, mandate that employers provide health insurance, impose a massive new tax burden on employers and heath care practitioners, and make our entitlement crisis worse by adding another open-ended entitlement;

    <o:p></o:p>
  • The Democratic plan would undermine the quality of American health care, displace those who are happy with their coverage, require painful rationing of care, and insert the government between doctors and patients: This would constrain the freedom of medical providers, limit patient options, and restrict the right of patients to make personal health care decisions in consultation with their doctor;

    <o:p></o:p>
  • The Democratic plan would vastly expand the reach of government into the private lives of American citizens and increase individual dependence on the state: It would have us trade individual liberty for the false promise of health security, and rather than having the federal government help to expand opportunities for you, their plan would provide more direct benefits and establish more boundaries and rules. This bureaucratization of American life stifles the energy and ingenuity that make our country great.

    <o:p></o:p>
  • Republicans have a better approach: Republicans do not deny the severity of the problem of health care costs, but we know that any solution must respect doctor and patient privacy, must restrain spending and not increase it, and must use the energy of our free market system rather than drain it. We have just a solution—one focused on the real problems in health care financing, rather than driven by an ideological desire to expand the government. <o:p></o:p>
<o:p> </o:p>
I. Government-Driven Health Care Less “Inevitable” Today Than In 1993 With The <st1:place w:st="on"><st1:city w:st="on">Clinton</st1:city></st1:place> Plan<o:p></o:p>
<o:p> </o:p>
The Clinton Administration in 1993 pushed hard for Congress to enact a government-run health care plan. At first, enactment seemed all but inevitable. Yet within a few months, a strong and united Republican response together with growing popular doubts about the quality and cost of government health care stalled and defeated it, causing a popular backlash later symbolized by <st1:city w:st="on"><st1:place w:st="on">Clinton</st1:place></st1:city>’s statement that “the era of big government is over.” That experience showed that Republicans must not accept the claim that government health care is “inevitable.” If we work to bring about real reform and real results – if we tirelessly point out the flaws of government-run health care and tirelessly offer better alternatives – it can be prevented again.<o:p></o:p>
<o:p> </o:p>
Since the <st1:city w:st="on"><st1:place w:st="on">Clintons</st1:place></st1:city>’ plan was defeated, two things have happened:<o:p></o:p>
<o:p> </o:p>
First, health care itself has had great successes in the development of new technologies and treatments for many illnesses, helping Americans live longer and healthier lives than ever. In fact, an overwhelming amount of survey data shows that about 80 percent of Americans say they are satisfied with the quality of their health care and about 75 percent are happy with their current health care coverage.<o:p></o:p>
<o:p> </o:p>
Second, however, a clear public consensus has grown that the delivery of health care services has become too costly and inaccessible to millions of households. Our people and government are together spending larger shares of their limited resources on health care than ever before. There are distortions in our system of health care delivery that must be addressed.<o:p></o:p>
<o:p> </o:p>
The Majority in Congress has not leveled with the American people about the real nature of their health care plan. And there is hard evidence that the radical transformation of the nation’s health care system which they are planning behind closed doors is politically vulnerable. A recent Pew Research poll compares the public’s appetite for a government-driven overhaul in 1993 and today, and it provides conclusions that should strengthen our resolve on this issue. Since the failed 1993 effort, the Pew poll finds that Americans today are less supportive of the idea our health care system needs to be “completely rebuilt”, more favorable to making “only minor changes”, and increasingly concerned with limiting costs relative to expanding access. Nowhere is there much endorsement of anything close to the extreme vision Democrats are pursuing so intently.<o:p></o:p>
<o:p> </o:p>
Echoing the Pew data, Democratic pollster Stanley Greenberg recently found in his own research that on question after question the appetite for a radical health care agenda has waned since the 1993 failure. In a piece written in The New Republic, Greenberg laments that “the desire for change and support for reform was slightly stronger 16 years ago".<o:p></o:p>
<o:p> </o:p>
The latest talking points from Democrats reflect the need to conceal their policies behind poll-friendly, basically Republican rhetoric. For example, they complain about the growing cost of entitlement spending, namely Medicare and Medicaid, and yet their solution is to create a new open-ended health entitlement. They claim to want more competition to keep private health insurers honest, but they propose a government insurance entity that would crowd out and ultimately replace the private insurance market. They speak Republican language about “investments” and “incentives,” but their government-run program would replace incentives with directives and private investment with taxpayer subsidies. They disavow any plan for “socialized medicine,” but the Majority’s proposal would smother private providers leaving the government to monopolize the entire health care field, “socialist” in all but name and by any reasonable definition.<o:p></o:p>
<o:p> </o:p>
Cognizant of Pew’s findings that a majority of Americans disagree with the assertion that health care in <st1:country-region w:st="on"><st1:place w:st="on">America</st1:place></st1:country-region> needs to be “completely rebuilt,” the President and Congressional leaders emphasize instead that they simply want to build upon “what works” in our current system. Heeding Greenberg’s conclusion that “three-quarters of Americans are satisfied with their own health insurance,” those pushing a plan that would force millions to be dumped onto government insurance echo the false refrain: “If you like what you got, you can keep it.” Nonpartisan studies from the CBO and independent actuarial firms refute these claims, presenting an unpleasant truth that is slowly creeping into the national debate. As a recent Associated Press story noted: “White House officials suggest the President's rhetoric shouldn't be taken literally.”<o:p></o:p>
<o:p> </o:p>
As the gap between substance and rhetoric widens, more and more news accounts and commentary are saying that the success of the health care crusade “suddenly appears in real jeopardy”. We Republicans are being presented with a critical opportunity. Encouraging data and a shift in popular perception should embolden our cause. Republicans must step up to grasp this opportunity and meet the challenge.<o:p></o:p>
<o:p> </o:p>
II. New Costs And New Taxes In The Democratic Proposals<o:p></o:p>
<o:p> </o:p>
Without an open debate or even a specific bill, no one knows exactly how costly the Democratic health care proposal will be. Some estimates have been made, however, and the President himself has made proposals that we should understand carefully.<o:p></o:p>
<o:p> </o:p>
-Early estimates from the CBO indicate that Democratic health care proposals will cost more than 1 trillion dollars over ten years. Private firms are estimating those numbers could rise to 4 trillion once all program expansions for Medicare and Medicaid are taken into account.<o:p></o:p>
<o:p> </o:p>
-$600 billion of this cost are supposed to come from a combination of Medicare provider cuts and some $300 billion in income tax hikes in upper tax brackets.<o:p></o:p>
<o:p> </o:p>
-President Obama recently proposed an additional $313 billion in Medicare and Medicaid provider cuts over ten years, including:<o:p></o:p>
<o:p> </o:p>
<o:p> </o:p>
oCuts in payments to providers to reflect “efficiencies” supposed to save $110 billion over the next decade. Basically, this is bureaucratic speak for cutting doctors’ and hospitals’ reimbursement rates.<o:p></o:p>
<o:p> </o:p>
oCuts in federal subsidies to hospitals that treat large populations of uninsured patients, justified by the assumption that everyone will be insured now. This is estimated to save $106 billion over ten years.<o:p></o:p>
<o:p> </o:p>
oCuts in federal payments to pharmaceutical companies to provide prescription drugs to seniors and others, saving $75 billion over the next decade. These cuts are in effect price controls on the Medicare Part D prescription drug program.<o:p></o:p>
<o:p> </o:p>
-A portion of the bill now being written in the Senate Health, Education, Labor, and Pensions Committee is being estimated to cost about $1 trillion. But CBO has not yet scored three major pieces (government option, employer mandate, and Medicaid expansion) that will drive the cost far higher. The nonpartisan Lewin Group, mentioned above, estimates the Medicaid expansion portion (a 50% enrollment increase to cover 60 million people, or one in five Americans) would cost nearly $911 billion over a decade. HSI Network, another private research group, has estimated this Senate Committee bill at $4 trillion for the same time period.<o:p></o:p>
<o:p> </o:p>
-The Senate Finance Committee is working on several tax increases, including:<o:p></o:p>
<o:p> </o:p>
oA tax on employer-provided health benefits (and so on most working Americans) to generate anywhere from $100 billion to $400 billion over 10 years.<o:p></o:p>
<o:p> </o:p>
oA 10-cent tax on sugary drinks ($110 billion), an increase in the alcohol tax ($61.5 billion), a 2% surtax on wealthier taxpayers, and a 0.375% increase in the Medicare portion of the payroll tax paid by all workers ($600 billion).<o:p></o:p>
<o:p> </o:p>
oEliminating deductions for pharmaceutical advertising ($37.5 billion).<o:p></o:p>
<o:p> </o:p>
-The House Democrats’ proposals are even more secretive, but they are reported to be planning $600 billion in Medicare cuts and $600 billion in tax hikes, such as higher payroll taxes or a new VAT tax. The proposed 8% “pay-or-play” tax on workers would push <st1:country-region w:st="on"><st1:place w:st="on">America</st1:place></st1:country-region>’s payroll tax rate to 23%. For those who chose not to buy health insurance, they will be hit with an across the board 2% tax on Adjusted Gross Income.<o:p></o:p>
<o:p> </o:p>
The fiscal features of the Majority’s plans dodge the two basic problems at the heart of this issue. First, not a single dollar of any Medicare/Medicaid savings they claim to make is used to reduce deficit spending. Second, their so-called “offsets” do nothing to remove the government-driven market distortions (such as obsolete tax exclusions and Medicare/Medicaid payment structures) that are causing our health care delivery issues. Democrats argue—following these figures—that they “offset” the trillion-plus dollar cost of universal health care with a combination of tax increases and coverage cuts in other health care areas. Robbing Peter to pay Paul while taxing them both is not what <st1:place w:st="on"><st1:country-region w:st="on">America</st1:country-region></st1:place> needs for better health care delivery.<o:p></o:p>
<o:p> </o:p>
The high cost of coverage and care is the fundamental problem at the core of health care dilemmas. The mounting deficits and debt are the fundamental problems at the heart of our larger national fiscal crisis. The Democrats’ plans would make both problems significantly worse.<o:p></o:p>
<o:p> </o:p>
<o:p> </o:p>
III. How The Democrats’ “Public Option” Eliminates Choices And Undermines Quality<o:p></o:p>
<o:p> </o:p>
The Majority’s proposal for a “public option” in health insurance is a back-door plan to replace health care based on patient choice and market competition with bureaucratized medicine—not all at once but step by step. Their misuse of Republican language, their nervous ridicule of talk about “socialized medicine,” together with the gradualism of their plan demonstrate that they know the American people would repudiate openly admitted socialized medicine.<o:p></o:p>
<o:p> </o:p>
The most urgent Republican task is to explain to Americans that under this new health care entitlement, the federal government would serve as both referee and player in the same game, creating a predetermined outcome whereby more and more families lose the coverage they now have and are forced into government-run insurance.<o:p></o:p>
<o:p> </o:p>
How drastic would the loss of coverage be? One nonpartisan study by the Lewin Group estimated that nearly 120 million Americans would lose their private health insurance under health reforms proposed by the candidates in last year’s Democratic presidential primary campaign. More recently, the CBO stated that an estimated 23 million Americans would no longer be covered under the proposal coming from the Senate Health, Education, Labor, and Pensions Committee. As these studies indicate, a “public option” plan cannot be put alongside existing private alternative options without forcing millions of Americans out of the health plan they prefer and into the government insurance option, which will become a government insurance monopoly.<o:p></o:p>
<o:p> </o:p>
Here is how it works: the federal government “option” would pay doctors at below market prices in order to “control costs.” When the government short-changes doctors, the rest of us will be forced to make up the difference: those not on the government plan will have to pay more for the same care. If the government plan will only pay $50 to your doctor for a procedure that costs $100, then your doctor will be forced to charge you $150 for the same procedure to make up the difference.With costs continuing to mount, employers will increasingly find it more cost-effective to drop private coverage altogether and dump their employees into the government plan. The President has yet to reconcile the fact that millions will be forced into the government option with his vague promise that “if you like what you got, you can keep it.”<o:p></o:p>
<o:p> </o:p>
As more people find themselves forced into the government plan, the only way to contain costs will be through rationing. The decision as to whether or not you get a hip replaced will not be a decision you or your doctor will make, it is a decision your government will make. The Majority in Congress has already set up the bureaucratic institution to make these rationing decisions; they simply need the government insurance plan to seal the deal.<o:p></o:p>
<o:p> </o:p>
A government monopoly of health care will have serious consequences. It will:<o:p></o:p>
-Eliminate patient choice,<o:p></o:p>
-Ration access to care, most painfully for society’s most vulnerable, and <o:p></o:p>
-Reduce incentives for robust medical research and for talented people to choose careers in health care.<o:p></o:p>
<o:p> </o:p>
Even if the formal “public plan” is stripped from the Democrats’ bill, they would still pursue these ends by the combination of regulations and mandates that would remain. The “public option” is not the core of the problem with their approach: government control of health insurance is the core of the problem. <o:p></o:p>
<o:p> </o:p>
IV. What Republicans Must Avoid<o:p></o:p>
<o:p> </o:p>
It is important for Republicans to resist the temptation to narrow the health care debate to focus exclusively on relative cost-benefit analyses. Of course it is true and essential to show the excessive price for the Majority’s plan, and this will be an important part of our argument. But if the Republicans’ only response smacks of accounting objections to helping people when popular concern about access to health care is growing, all the number crunching in the world will not be persuasive.<o:p></o:p>
<o:p> </o:p>
In addition, if the only objection we have is about dollars, Democrats will easily find some cost-reducing “compromise” to buy Republican support and give us short-term emotional satisfaction in sharing “bipartisan credit.” But any such compromise will still result in the long-term victory of government-monopolized health care. Whether the initial version enacted is modest or comprehensive, any option that includes government-provided services will:<o:p></o:p>
-undermine <st1:country-region w:st="on"><st1:place w:st="on">US</st1:place></st1:country-region> health care delivery in the long term,<o:p></o:p>
-prove impossible to reverse, and<o:p></o:p>
-accelerate us toward a tipping point on the question of the role of government.<o:p></o:p>
<o:p> </o:p>
V. Why Republicans Are Offering Real Alternative Reforms<o:p></o:p>
<o:p> </o:p>
Republicans cannot win this debate only by opposing Democratic proposals. We must also promote real reforms that address the growing problems that concern Americans about the delivery of health care services. Because Republicans have a solid commitment to the moral case for free market democracy, we are in a strong position to bring forward better ideas and proposals that can fix the real problems in the delivery of health care without sacrificing principles.<o:p></o:p>
<o:p> </o:p>
Republicans have already offered, or are working on, a number of thoughtful alternative solutions consistent with our principles and effective in practice, removing government-driven market distortions to increase the availability of health care. Senators Tom Coburn and Richard Burr, Rep. Devin Nunes, and I have coauthored one proposal we named the Patients’ Choice Act of 2009. This bill is by no means the last word in reform alternatives, but we take pride in having proposed it long before any actual plan had been offered by the Majority. This bill demonstrates the commitment of Republicans to address serious health care delivery issues with solutions based on freedom, competition, and patients’ choice. Led by Reps. Roy Blunt, Dave Camp, Joe Barton, and others, the House Republican Health Care Solutions Working Group recently unveiled a comprehensive health care alternative grounded on these same principles. Other House Republicans – from Rep. John Shadegg’s interstate shopping proposal to Rep. Mark Kirk’s Medical Rights and Reform Act – continue to demonstrate policy entrepreneurship, and have made clear we are committed to advancing substantive reforms. Republican proposals show that many more uninsured Americans can be covered by spending current dollars more wisely and efficiently, rather than by spending additional billions as the Democrats propose. With multiple alternative proposals in hand, we Republicans hold the high ground, and we should demand that the Democratic Majority tell the American people why they reject free market democratic solutions that respect the decisions and choices of the individuals receiving and paying for health care.<o:p></o:p>
<o:p> </o:p>
Republican policies reflect an approach to the problems of our society which is solidly anchored in timeless principles accepted by a consensus of Americans, combining a moral commitment to beliefs about right and wrong with a commitment to economic well-being. Americans look to ideals such as personal freedom, equal natural rights and opportunity, and government by popular consent as guides to practical solutions that secure the interests of all. <st1:country-region w:st="on"><st1:place w:st="on">America</st1:place></st1:country-region> long ago adopted this “practical idealism” in the form of free market democracy.<o:p></o:p>
<o:p> </o:p>
Sadly, Democrats have abandoned Americans’ practical idealism, instead pushing their nationalized health program by manipulating guilt and provoking envy. The Republican response must appeal to the economic and moral norms of free market democracy which honor and expand consumer choice and producer competition, regulated to enforce honesty, transparency, and fair play. Beyond doubt, free market democracy is still the most successful means yet discovered to improve the well-being and prosperity of individuals and society.<o:p></o:p>
<o:p> </o:p>
When free markets apparently are failing to satisfy the needs of consumers and dissatisfaction grows—as in the provision of health care services—Washington typically misdiagnoses the problem by rushing to blame competition and economic freedom. Often the real cause, though, is the unintended consequences of government-driven interventions in the free market shrinking the provision of services to a few oversized entities. Republicans do not believe that the answer to bureaucratic red tape, gate keeping, and rising costs is to replace them with a single bureaucratic provider armed with the power to stifle its competitors. This is the Majority’s health care plan in a nutshell. The Republican response is to refocus on expanding the supply of health care producers and consumer-driven choices, which we believe is the superior means to achieving universal access to affordable, quality health care.<o:p></o:p>
<o:p> </o:p>
The delivery of health care services is one of the nation’s highest priorities, and it should be. Far from justifying a government takeover of health care which will drive up needless demands for services, the overwhelming importance of this priority is exactly why the health care delivery system must be reformed to increase patient choice, encourage market-based competition for health services, bring down health costs, and increase the supply of health insurance. In any fair debate between government-centered health care where medical decisions are made by bureaucrats versus patient choice empowered by free market competition among health providers, the practical idealism of the American people will prefer individual choice and market freedom.<o:p></o:p>
<o:p> </o:p>
VI. Health Care Providers Must Engage Actively In This Debate<o:p></o:p>
<o:p> </o:p>
Every provider of health-related services – including physicians and nurses, assistants, hospitals and clinics – will be profoundly affected by the outcome of the debate taking place inside the Beltway. Either health care will travel down the path taken by most European countries, <st1:country-region w:st="on"><st1:place w:st="on">Canada</st1:place></st1:country-region>, and other nations with socialized medicine, or it will be reformed to enable practitioners to return to the pursuit of health care excellence. Countries that have chosen nationalized health services have eradicated individual competition and stunted innovation. They have done this by eliminating the incentives to outperform since medical professionals become salaried government workers without adequate rewards for exceeding average standards. Government-driven health care poses at least three major threats to providers.<o:p></o:p>
<o:p> </o:p>
First: The practice of every aspect of government-monopolized medicine inevitably will be reduced to “cookie cutter” standards. Every health care provider knows that patients’ conditions are not exactly the same, and treatments must be tailored to unique needs. Health care excellence like this is only possible under a vibrant free market and not under “one-size-fits-all” regulations of government-controlled health care.<o:p></o:p>
<o:p> </o:p>
Second: The cost and price structure of nationalized medical services are controlled and distorted by price controls dictated by political demands for low rates of reimbursement. There is no lack of historical experience with price and wage controls and their harmful consequences. The principal result is shrinking supplies of price controlled human and material resources, and thus the necessity of managing the decline. In the health care field, shortages must be rationed by deciding who shall receive and who shall be denied life-saving medicines and essential services. Patients with the greatest needs and groups deemed less worthy of treatment are likely to be the first victims of bureaucratically determined health care rationing.<o:p></o:p>
<o:p> </o:p>
Third: Government-run health services build barriers to the most talented young men and women thinking of a medical career. At the very time when there is a growing need for more talented medical practitioners to care for aging boomers, young people with ability and skill will not take on the long years of education and incur substantial student loans just to become de facto government staffers whose type and place of practice and whose reimbursement rates are dictated by federal agencies.<o:p></o:p>
<o:p> </o:p>
These threats, if they become law, will prove lethal to <st1:country-region w:st="on"><st1:place w:st="on">America</st1:place></st1:country-region>’s health care providers. It means we will be on the path to socialized medicine. It is understandable that the Congressional Majority ridicules the claim that this is their objective, but the “public option” insurance plan which they propose as “an important tool to discipline insurance companies," in the recent words of the President, must lead step-by-step down that road. Mocking a fact does not make it untrue. And all we ask is that Democrats call their plan by its rightful name.<o:p></o:p>
<o:p> </o:p>
Health care providers, whether private insurers, doctors, hospitals, or trade associations must resist the temptation to “cut a deal” that would trade some benefit (some type of medical malpractice reform, for instance) in return for silence or outright support for the Majority’s proposal. That “deal” would only buy a little time after which the competitive health care market will be transformed into a nationalized monopoly under which every provider will lose its independence once government is the single payer for medical services.<o:p></o:p>
<o:p> </o:p>
Every day <st1:country-region w:st="on"><st1:place w:st="on">America</st1:place></st1:country-region>’s health care professionals meet the most critical medical needs of our people with a selfless dedication too often overlooked. They deserve our thanks. And they deserve our understanding that the excellence of care they provide cannot continue under a health care government monopoly. In the struggle between their right to practice and compete under free market democracy versus nationalized health service, <st1:country-region w:st="on"><st1:place w:st="on">America</st1:place></st1:country-region>’s dedicated health care providers must not stand to one side. Providers must engage in this struggle for the future of their high profession and commitment to the wellness of the American people.<o:p></o:p>
<o:p> </o:p>
VII. What Is Really At Stake In This Debate?<o:p></o:p>
European Social Welfare State or American Free Market Democracy<o:p></o:p>
<o:p> </o:p>
As important as this debate over the future of health care is, the ramifications go beyond simply health care. This debate may well prove to be a surrogate for the defining issue of our generation: The nature of democratic self-government and whether this great American experiment in individual freedom will be cast aside as inadequate to today’s concerns.<o:p></o:p>
<o:p> </o:p>
If this sounds hyperbolic, consider: <st1:country-region w:st="on"><st1:place w:st="on">America</st1:place></st1:country-region>’s private and public sector already spend about $2.5 trillion a year on health care, more than twice what any other country spends per person, amounting to some 17 percent of our nation’s GDP. If government is now to take over the whole cost burden as another entitlement, the transformation of our society into a European-style social welfare state will be unstoppable. This democratic system under which each citizen takes active responsibility for working to fulfill his or her potential, maturely judging risks and rewards, will be replaced by a nation of passive subjects grateful to government leaders for anything they receive to satisfy their needs, desires, and dreams.<o:p></o:p>
<o:p> </o:p>
The Democratic health care program is a means to a larger end. If President Obama and his party truly want “more competition,” as they say, why propose government insurance instead of enabling more non-profit insurance? If they have no intention of transforming the system into Medicare for all, why do they tie all payments to Medicare? If they have no design to ration health care, why did they tuck in the stimulus package’s fine print a new Institute for Comparative Effectiveness similar to <st1:country-region w:st="on">Britain</st1:country-region>’s National Institute for Health and Clinical Excellence (NICE), which interferes in health technology development in order to lower costs under <st1:country-region w:st="on"><st1:place w:st="on">Britain</st1:place></st1:country-region>’s nationalized health service? This Institute’s stated purpose is to identify medical practices that produce outcomes that “work” as opposed to those that “don’t work.” But under a national health care insurance plan, just as we see in Medicare even now, providers will not be paid out of the plan for health care which the Institute disapproves of. Once competing plans have been driven out of business, the result will be that the government’s approval or disapproval alone will dictate the care providers may offer to beneficiaries. Without any other resource for heath care payments, government decisions through the Institute about “what works” and “what does not work” will automatically result in denying procedures or treatments for certain categories of patients.<o:p></o:p>
<o:p> </o:p>
Finally, if the Majority is so worried about our skyrocketing national debt and the burden on the next generation, why do they want to create an entirely new entitlement that would deal a staggering blow to our economy – an entitlement that rivals the size and liabilities of Medicare?<o:p></o:p>
<o:p> </o:p>
Perhaps because this is ultimately not about health care but about advancing a larger, and I believe pernicious, ideological crusade. The nation that was founded on the belief that our unalienable rights were granted to us not by government but by “nature and nature’s God” will be remade into a “benevolent” social welfare state. Government-run health care is the first step down that path.<o:p></o:p>
<o:p> </o:p>
Compare the Canadian health care system, which liberals often point to as a model for the <st1:country-region w:st="on"><st1:place w:st="on">U.S.</st1:place></st1:country-region> The government is the single payer for health service, though most providers are in the private sector. In <st1:country-region w:st="on"><st1:place w:st="on">Canada</st1:place></st1:country-region> the waiting list is up to more than 4 months between patient referrals and actual treatment for a dozen of the specialty procedures most needed. The average Canadian now has to wait over a month after getting a primary doctor’s instruction just to get a CT scan, and more than two months for an MRI. <st1:country-region w:st="on"><st1:place w:st="on">Canada</st1:place></st1:country-region>’s medical equipment is old, unreliable, and obsolete. Canadians, famous and not so famous, travel to the <st1:country-region w:st="on"><st1:place w:st="on">U.S.</st1:place></st1:country-region> if they can for treatments for everything from cancers and emergency care to hip surgery and childbirth. <st1:country-region w:st="on">Canada</st1:country-region> has long suffered a professional “brain drain,” its doctors fleeing the government-run health care program to practice in the <st1:country-region w:st="on"><st1:place w:st="on">U.S.</st1:place></st1:country-region> The U.S. Government tried to make this more difficult, yet according to a 2007 report, one in nine doctors trained in <st1:country-region w:st="on"><st1:place w:st="on">Canada</st1:place></st1:country-region> is now practicing medicine here. But where will Americans, whether uncared-for patients or government medical workers, go to when the <st1:country-region w:st="on"><st1:place w:st="on">U.S.</st1:place></st1:country-region> also has socialized health care? There is no place of freedom left. Either we keep free market democracy here, or it will enter the history books as civilization’s great but unsuccessful experiment in human liberty.<o:p></o:p>
<o:p> </o:p>
It falls to Republicans to prevent that from happening. It rests with us to keep <st1:country-region w:st="on"><st1:place w:st="on">America</st1:place></st1:country-region> on the path of free markets, which has served us so well in the past, which has lifted countless people out of poverty, and which can lead Americans to a healthier and more prosperous future. This is the moment in which we need to step up and be counted, in which we fight for the principles on which this nation was founded and to which it must remain committed. The stakes could hardly be higher.<o:p></o:p>
<o:p> </o:p>
Our members should concentrate all of our attention on getting this message out to our constituents and the entire country, using all the means from speeches and letters to the many new media formats available to do this.<o:p></o:p>
<o:p> </o:p>
###<o:p></o:p>

To learn more about The Patients’ Choice Act of 2009: http://www.house.gov/ryan/PCA <o:p></o:p>
For the latest from Paul Ryan: http://twitter.com/reppaulryan |http://www.facebook.com/reppaulryan | http://www.youtube.com/reppaulryan | http://www.house.gov/ryan <o:p></o:p>

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MEMORANDUM<o:p></o:p>
<o:p> </o:p>
TO: HOUSE REPUBLICANS AND OTHER INTERESTED PARTIES<o:p></o:p>
FROM: REP. PAUL RYAN<o:p></o:p>
DATE: JUNE 24, 2009<o:p></o:p>
<o:p> </o:p>
A STRATEGY TO STOP GOVERNMENT-RUN HEALTH CARE AND IMPROVE <st1:place w:st="on"><st1:country-region w:st="on">AMERICA</st1:country-region></st1:place>’S HEALTH CARE SYSTEM<o:p></o:p>
<o:p> </o:p>
---<o:p></o:p>
<o:p> </o:p>
Summary<o:p></o:p>
<o:p> </o:p>
The Administration and the Democratic Majority in Congress are mounting an all-out rush to force a government-run health care measure through Congress without anything close to the robust public scrutiny and debate such a radical and untested new entitlement program requires. The Majority’s rush to judgment may be politically expedient, but it is extremely irresponsible, unwise, and unfair to the people of this country.<o:p></o:p>
<o:p> </o:p>
With a united strategy, we Republicans have it in our power to expose the irreversible consequences of this reckless course. We can go to the nation, explain what is happening, and engage the American people in a serious, timely, and comprehensive discussion about health care and the alternative choices before them. No other issue before Congress is as urgent as this. All of us together, beginning now, must focus the nation’s undivided attention on this issue.<o:p></o:p>
<o:p> </o:p>
This memo’s purpose is to describe the health care debate in ways that most Americans can understand and to offer a united strategy for addressing it.<o:p></o:p>
<o:p> </o:p>
---<o:p></o:p>
<o:p> </o:p>
Introduction<o:p></o:p>
<o:p> </o:p>
We have reached a crucial moment, and perhaps a historical tipping point, on health care specifically and free market democracy more broadly. The next few months are likely to define the fight for limited government and free market economics for many years to come. The debate over government-controlled health care is critical to the future of Americans’ health, <st1:place w:st="on"><st1:country-region w:st="on">America</st1:country-region></st1:place>’s prosperity, and American vitality, but the American people are being denied the opportunity to consider and to understand its implications. <o:p></o:p>
<o:p> </o:p>
The Administration and the Democratic Majority in Congress are mounting an all-out rush to force a government-run health care measure through Congress without anything close to the robust public scrutiny and debate such a radical and untested new entitlement program requires. The Majority’s rush to judgment may be politically expedient, but it is extremely irresponsible, unwise, and unfair to the people of this country.<o:p></o:p>
<o:p> </o:p>
This strategy is also self-contradictory: if the Democrats believe their plan will establish a sweeping and comprehensive transformation of the way our nation provides for our people’s health care, why would they deny Americans sufficient time for careful examination, thorough deliberation, and responsible public discussion of the details of their proposal? Why the rush to judgment of an untested experiment with our nation’s health?<o:p></o:p>
<o:p> </o:p>
With a united strategy, we Republicans have it in our power to demand that this reckless course be stopped. We can go to the nation, explain what is happening, and engage the American people in a serious, timely, and comprehensive discussion about health care and the consequences of the alternative choices before them. No other issue before Congress is as urgent as this. All of us together, beginning now, must focus the nation’s undivided attention on this issue. This memo’s purpose is to describe the health care debate in ways that most Americans can understand and to offer a united strategy for addressing it.<o:p></o:p>
<o:p> </o:p>
The American public is being presented with a false choice between accepting a government takeover of health care or doing nothing. But there is a third way – a patient-centered reform model – which we Republicans must advocate with one voice, clearly and effectively. For too long Republicans have been timid when talking about health care. This has been a huge mistake on our part. We have creative, excellent, and timely ideas on how to improve health care; this is an issue that, like welfare reform and fighting crime in decades past, we should come to own. <o:p></o:p>
<o:p> </o:p>
As the Democrats’ legislation is gradually revealed, Republicans must frame the debate candidly and clearly, and we must win this debate. To win this debate, Republicans must demonstrate four essential points:<o:p></o:p>
<o:p> </o:p>

  • The Democratic plan is outrageously expensive and fiscally irresponsible: it will fail to control health care costs, will exacerbate our growing debt, and will require crushing taxes: Their approach would spend trillions more dollars, mandate that employers provide health insurance, impose a massive new tax burden on employers and heath care practitioners, and make our entitlement crisis worse by adding another open-ended entitlement;

    <o:p></o:p>
  • The Democratic plan would undermine the quality of American health care, displace those who are happy with their coverage, require painful rationing of care, and insert the government between doctors and patients: This would constrain the freedom of medical providers, limit patient options, and restrict the right of patients to make personal health care decisions in consultation with their doctor;

    <o:p></o:p>
  • The Democratic plan would vastly expand the reach of government into the private lives of American citizens and increase individual dependence on the state: It would have us trade individual liberty for the false promise of health security, and rather than having the federal government help to expand opportunities for you, their plan would provide more direct benefits and establish more boundaries and rules. This bureaucratization of American life stifles the energy and ingenuity that make our country great.

    <o:p></o:p>
  • Republicans have a better approach: Republicans do not deny the severity of the problem of health care costs, but we know that any solution must respect doctor and patient privacy, must restrain spending and not increase it, and must use the energy of our free market system rather than drain it. We have just a solution—one focused on the real problems in health care financing, rather than driven by an ideological desire to expand the government. <o:p></o:p>
<o:p> </o:p>
I. Government-Driven Health Care Less “Inevitable” Today Than In 1993 With The <st1:place w:st="on"><st1:city w:st="on">Clinton</st1:city></st1:place> Plan<o:p></o:p>
<o:p> </o:p>
The Clinton Administration in 1993 pushed hard for Congress to enact a government-run health care plan. At first, enactment seemed all but inevitable. Yet within a few months, a strong and united Republican response together with growing popular doubts about the quality and cost of government health care stalled and defeated it, causing a popular backlash later symbolized by <st1:city w:st="on"><st1:place w:st="on">Clinton</st1:place></st1:city>’s statement that “the era of big government is over.” That experience showed that Republicans must not accept the claim that government health care is “inevitable.” If we work to bring about real reform and real results – if we tirelessly point out the flaws of government-run health care and tirelessly offer better alternatives – it can be prevented again.<o:p></o:p>
<o:p> </o:p>
Since the <st1:city w:st="on"><st1:place w:st="on">Clintons</st1:place></st1:city>’ plan was defeated, two things have happened:<o:p></o:p>
<o:p> </o:p>
First, health care itself has had great successes in the development of new technologies and treatments for many illnesses, helping Americans live longer and healthier lives than ever. In fact, an overwhelming amount of survey data shows that about 80 percent of Americans say they are satisfied with the quality of their health care and about 75 percent are happy with their current health care coverage.<o:p></o:p>
<o:p> </o:p>
Second, however, a clear public consensus has grown that the delivery of health care services has become too costly and inaccessible to millions of households. Our people and government are together spending larger shares of their limited resources on health care than ever before. There are distortions in our system of health care delivery that must be addressed.<o:p></o:p>
<o:p> </o:p>
The Majority in Congress has not leveled with the American people about the real nature of their health care plan. And there is hard evidence that the radical transformation of the nation’s health care system which they are planning behind closed doors is politically vulnerable. A recent Pew Research poll compares the public’s appetite for a government-driven overhaul in 1993 and today, and it provides conclusions that should strengthen our resolve on this issue. Since the failed 1993 effort, the Pew poll finds that Americans today are less supportive of the idea our health care system needs to be “completely rebuilt”, more favorable to making “only minor changes”, and increasingly concerned with limiting costs relative to expanding access. Nowhere is there much endorsement of anything close to the extreme vision Democrats are pursuing so intently.<o:p></o:p>
<o:p> </o:p>
Echoing the Pew data, Democratic pollster Stanley Greenberg recently found in his own research that on question after question the appetite for a radical health care agenda has waned since the 1993 failure. In a piece written in The New Republic, Greenberg laments that “the desire for change and support for reform was slightly stronger 16 years ago".<o:p></o:p>
<o:p> </o:p>
The latest talking points from Democrats reflect the need to conceal their policies behind poll-friendly, basically Republican rhetoric. For example, they complain about the growing cost of entitlement spending, namely Medicare and Medicaid, and yet their solution is to create a new open-ended health entitlement. They claim to want more competition to keep private health insurers honest, but they propose a government insurance entity that would crowd out and ultimately replace the private insurance market. They speak Republican language about “investments” and “incentives,” but their government-run program would replace incentives with directives and private investment with taxpayer subsidies. They disavow any plan for “socialized medicine,” but the Majority’s proposal would smother private providers leaving the government to monopolize the entire health care field, “socialist” in all but name and by any reasonable definition.<o:p></o:p>
<o:p> </o:p>
Cognizant of Pew’s findings that a majority of Americans disagree with the assertion that health care in <st1:country-region w:st="on"><st1:place w:st="on">America</st1:place></st1:country-region> needs to be “completely rebuilt,” the President and Congressional leaders emphasize instead that they simply want to build upon “what works” in our current system. Heeding Greenberg’s conclusion that “three-quarters of Americans are satisfied with their own health insurance,” those pushing a plan that would force millions to be dumped onto government insurance echo the false refrain: “If you like what you got, you can keep it.” Nonpartisan studies from the CBO and independent actuarial firms refute these claims, presenting an unpleasant truth that is slowly creeping into the national debate. As a recent Associated Press story noted: “White House officials suggest the President's rhetoric shouldn't be taken literally.”<o:p></o:p>
<o:p> </o:p>
As the gap between substance and rhetoric widens, more and more news accounts and commentary are saying that the success of the health care crusade “suddenly appears in real jeopardy”. We Republicans are being presented with a critical opportunity. Encouraging data and a shift in popular perception should embolden our cause. Republicans must step up to grasp this opportunity and meet the challenge.<o:p></o:p>
<o:p> </o:p>
II. New Costs And New Taxes In The Democratic Proposals<o:p></o:p>
<o:p> </o:p>
Without an open debate or even a specific bill, no one knows exactly how costly the Democratic health care proposal will be. Some estimates have been made, however, and the President himself has made proposals that we should understand carefully.<o:p></o:p>
<o:p> </o:p>
-Early estimates from the CBO indicate that Democratic health care proposals will cost more than 1 trillion dollars over ten years. Private firms are estimating those numbers could rise to 4 trillion once all program expansions for Medicare and Medicaid are taken into account.<o:p></o:p>
<o:p> </o:p>
-$600 billion of this cost are supposed to come from a combination of Medicare provider cuts and some $300 billion in income tax hikes in upper tax brackets.<o:p></o:p>
<o:p> </o:p>
-President Obama recently proposed an additional $313 billion in Medicare and Medicaid provider cuts over ten years, including:<o:p></o:p>
<o:p> </o:p>
<o:p> </o:p>
oCuts in payments to providers to reflect “efficiencies” supposed to save $110 billion over the next decade. Basically, this is bureaucratic speak for cutting doctors’ and hospitals’ reimbursement rates.<o:p></o:p>
<o:p> </o:p>
oCuts in federal subsidies to hospitals that treat large populations of uninsured patients, justified by the assumption that everyone will be insured now. This is estimated to save $106 billion over ten years.<o:p></o:p>
<o:p> </o:p>
oCuts in federal payments to pharmaceutical companies to provide prescription drugs to seniors and others, saving $75 billion over the next decade. These cuts are in effect price controls on the Medicare Part D prescription drug program.<o:p></o:p>
<o:p> </o:p>
-A portion of the bill now being written in the Senate Health, Education, Labor, and Pensions Committee is being estimated to cost about $1 trillion. But CBO has not yet scored three major pieces (government option, employer mandate, and Medicaid expansion) that will drive the cost far higher. The nonpartisan Lewin Group, mentioned above, estimates the Medicaid expansion portion (a 50% enrollment increase to cover 60 million people, or one in five Americans) would cost nearly $911 billion over a decade. HSI Network, another private research group, has estimated this Senate Committee bill at $4 trillion for the same time period.<o:p></o:p>
<o:p> </o:p>
-The Senate Finance Committee is working on several tax increases, including:<o:p></o:p>
<o:p> </o:p>
oA tax on employer-provided health benefits (and so on most working Americans) to generate anywhere from $100 billion to $400 billion over 10 years.<o:p></o:p>
<o:p> </o:p>
oA 10-cent tax on sugary drinks ($110 billion), an increase in the alcohol tax ($61.5 billion), a 2% surtax on wealthier taxpayers, and a 0.375% increase in the Medicare portion of the payroll tax paid by all workers ($600 billion).<o:p></o:p>
<o:p> </o:p>
oEliminating deductions for pharmaceutical advertising ($37.5 billion).<o:p></o:p>
<o:p> </o:p>
-The House Democrats’ proposals are even more secretive, but they are reported to be planning $600 billion in Medicare cuts and $600 billion in tax hikes, such as higher payroll taxes or a new VAT tax. The proposed 8% “pay-or-play” tax on workers would push <st1:country-region w:st="on"><st1:place w:st="on">America</st1:place></st1:country-region>’s payroll tax rate to 23%. For those who chose not to buy health insurance, they will be hit with an across the board 2% tax on Adjusted Gross Income.<o:p></o:p>
<o:p> </o:p>
The fiscal features of the Majority’s plans dodge the two basic problems at the heart of this issue. First, not a single dollar of any Medicare/Medicaid savings they claim to make is used to reduce deficit spending. Second, their so-called “offsets” do nothing to remove the government-driven market distortions (such as obsolete tax exclusions and Medicare/Medicaid payment structures) that are causing our health care delivery issues. Democrats argue—following these figures—that they “offset” the trillion-plus dollar cost of universal health care with a combination of tax increases and coverage cuts in other health care areas. Robbing Peter to pay Paul while taxing them both is not what <st1:place w:st="on"><st1:country-region w:st="on">America</st1:country-region></st1:place> needs for better health care delivery.<o:p></o:p>
<o:p> </o:p>
The high cost of coverage and care is the fundamental problem at the core of health care dilemmas. The mounting deficits and debt are the fundamental problems at the heart of our larger national fiscal crisis. The Democrats’ plans would make both problems significantly worse.<o:p></o:p>
<o:p> </o:p>
<o:p> </o:p>
III. How The Democrats’ “Public Option” Eliminates Choices And Undermines Quality<o:p></o:p>
<o:p> </o:p>
The Majority’s proposal for a “public option” in health insurance is a back-door plan to replace health care based on patient choice and market competition with bureaucratized medicine—not all at once but step by step. Their misuse of Republican language, their nervous ridicule of talk about “socialized medicine,” together with the gradualism of their plan demonstrate that they know the American people would repudiate openly admitted socialized medicine.<o:p></o:p>
<o:p> </o:p>
The most urgent Republican task is to explain to Americans that under this new health care entitlement, the federal government would serve as both referee and player in the same game, creating a predetermined outcome whereby more and more families lose the coverage they now have and are forced into government-run insurance.<o:p></o:p>
<o:p> </o:p>
How drastic would the loss of coverage be? One nonpartisan study by the Lewin Group estimated that nearly 120 million Americans would lose their private health insurance under health reforms proposed by the candidates in last year’s Democratic presidential primary campaign. More recently, the CBO stated that an estimated 23 million Americans would no longer be covered under the proposal coming from the Senate Health, Education, Labor, and Pensions Committee. As these studies indicate, a “public option” plan cannot be put alongside existing private alternative options without forcing millions of Americans out of the health plan they prefer and into the government insurance option, which will become a government insurance monopoly.<o:p></o:p>
<o:p> </o:p>
Here is how it works: the federal government “option” would pay doctors at below market prices in order to “control costs.” When the government short-changes doctors, the rest of us will be forced to make up the difference: those not on the government plan will have to pay more for the same care. If the government plan will only pay $50 to your doctor for a procedure that costs $100, then your doctor will be forced to charge you $150 for the same procedure to make up the difference.With costs continuing to mount, employers will increasingly find it more cost-effective to drop private coverage altogether and dump their employees into the government plan. The President has yet to reconcile the fact that millions will be forced into the government option with his vague promise that “if you like what you got, you can keep it.”<o:p></o:p>
<o:p> </o:p>
As more people find themselves forced into the government plan, the only way to contain costs will be through rationing. The decision as to whether or not you get a hip replaced will not be a decision you or your doctor will make, it is a decision your government will make. The Majority in Congress has already set up the bureaucratic institution to make these rationing decisions; they simply need the government insurance plan to seal the deal.<o:p></o:p>
<o:p> </o:p>
A government monopoly of health care will have serious consequences. It will:<o:p></o:p>
-Eliminate patient choice,<o:p></o:p>
-Ration access to care, most painfully for society’s most vulnerable, and <o:p></o:p>
-Reduce incentives for robust medical research and for talented people to choose careers in health care.<o:p></o:p>
<o:p> </o:p>
Even if the formal “public plan” is stripped from the Democrats’ bill, they would still pursue these ends by the combination of regulations and mandates that would remain. The “public option” is not the core of the problem with their approach: government control of health insurance is the core of the problem. <o:p></o:p>
<o:p> </o:p>
IV. What Republicans Must Avoid<o:p></o:p>
<o:p> </o:p>
It is important for Republicans to resist the temptation to narrow the health care debate to focus exclusively on relative cost-benefit analyses. Of course it is true and essential to show the excessive price for the Majority’s plan, and this will be an important part of our argument. But if the Republicans’ only response smacks of accounting objections to helping people when popular concern about access to health care is growing, all the number crunching in the world will not be persuasive.<o:p></o:p>
<o:p> </o:p>
In addition, if the only objection we have is about dollars, Democrats will easily find some cost-reducing “compromise” to buy Republican support and give us short-term emotional satisfaction in sharing “bipartisan credit.” But any such compromise will still result in the long-term victory of government-monopolized health care. Whether the initial version enacted is modest or comprehensive, any option that includes government-provided services will:<o:p></o:p>
-undermine <st1:country-region w:st="on"><st1:place w:st="on">US</st1:place></st1:country-region> health care delivery in the long term,<o:p></o:p>
-prove impossible to reverse, and<o:p></o:p>
-accelerate us toward a tipping point on the question of the role of government.<o:p></o:p>
<o:p> </o:p>
V. Why Republicans Are Offering Real Alternative Reforms<o:p></o:p>
<o:p> </o:p>
Republicans cannot win this debate only by opposing Democratic proposals. We must also promote real reforms that address the growing problems that concern Americans about the delivery of health care services. Because Republicans have a solid commitment to the moral case for free market democracy, we are in a strong position to bring forward better ideas and proposals that can fix the real problems in the delivery of health care without sacrificing principles.<o:p></o:p>
<o:p> </o:p>
Republicans have already offered, or are working on, a number of thoughtful alternative solutions consistent with our principles and effective in practice, removing government-driven market distortions to increase the availability of health care. Senators Tom Coburn and Richard Burr, Rep. Devin Nunes, and I have coauthored one proposal we named the Patients’ Choice Act of 2009. This bill is by no means the last word in reform alternatives, but we take pride in having proposed it long before any actual plan had been offered by the Majority. This bill demonstrates the commitment of Republicans to address serious health care delivery issues with solutions based on freedom, competition, and patients’ choice. Led by Reps. Roy Blunt, Dave Camp, Joe Barton, and others, the House Republican Health Care Solutions Working Group recently unveiled a comprehensive health care alternative grounded on these same principles. Other House Republicans – from Rep. John Shadegg’s interstate shopping proposal to Rep. Mark Kirk’s Medical Rights and Reform Act – continue to demonstrate policy entrepreneurship, and have made clear we are committed to advancing substantive reforms. Republican proposals show that many more uninsured Americans can be covered by spending current dollars more wisely and efficiently, rather than by spending additional billions as the Democrats propose. With multiple alternative proposals in hand, we Republicans hold the high ground, and we should demand that the Democratic Majority tell the American people why they reject free market democratic solutions that respect the decisions and choices of the individuals receiving and paying for health care.<o:p></o:p>
<o:p> </o:p>
Republican policies reflect an approach to the problems of our society which is solidly anchored in timeless principles accepted by a consensus of Americans, combining a moral commitment to beliefs about right and wrong with a commitment to economic well-being. Americans look to ideals such as personal freedom, equal natural rights and opportunity, and government by popular consent as guides to practical solutions that secure the interests of all. <st1:country-region w:st="on"><st1:place w:st="on">America</st1:place></st1:country-region> long ago adopted this “practical idealism” in the form of free market democracy.<o:p></o:p>
<o:p> </o:p>
Sadly, Democrats have abandoned Americans’ practical idealism, instead pushing their nationalized health program by manipulating guilt and provoking envy. The Republican response must appeal to the economic and moral norms of free market democracy which honor and expand consumer choice and producer competition, regulated to enforce honesty, transparency, and fair play. Beyond doubt, free market democracy is still the most successful means yet discovered to improve the well-being and prosperity of individuals and society.<o:p></o:p>
<o:p> </o:p>
When free markets apparently are failing to satisfy the needs of consumers and dissatisfaction grows—as in the provision of health care services—Washington typically misdiagnoses the problem by rushing to blame competition and economic freedom. Often the real cause, though, is the unintended consequences of government-driven interventions in the free market shrinking the provision of services to a few oversized entities. Republicans do not believe that the answer to bureaucratic red tape, gate keeping, and rising costs is to replace them with a single bureaucratic provider armed with the power to stifle its competitors. This is the Majority’s health care plan in a nutshell. The Republican response is to refocus on expanding the supply of health care producers and consumer-driven choices, which we believe is the superior means to achieving universal access to affordable, quality health care.<o:p></o:p>
<o:p> </o:p>
The delivery of health care services is one of the nation’s highest priorities, and it should be. Far from justifying a government takeover of health care which will drive up needless demands for services, the overwhelming importance of this priority is exactly why the health care delivery system must be reformed to increase patient choice, encourage market-based competition for health services, bring down health costs, and increase the supply of health insurance. In any fair debate between government-centered health care where medical decisions are made by bureaucrats versus patient choice empowered by free market competition among health providers, the practical idealism of the American people will prefer individual choice and market freedom.<o:p></o:p>
<o:p> </o:p>
VI. Health Care Providers Must Engage Actively In This Debate<o:p></o:p>
<o:p> </o:p>
Every provider of health-related services – including physicians and nurses, assistants, hospitals and clinics – will be profoundly affected by the outcome of the debate taking place inside the Beltway. Either health care will travel down the path taken by most European countries, <st1:country-region w:st="on"><st1:place w:st="on">Canada</st1:place></st1:country-region>, and other nations with socialized medicine, or it will be reformed to enable practitioners to return to the pursuit of health care excellence. Countries that have chosen nationalized health services have eradicated individual competition and stunted innovation. They have done this by eliminating the incentives to outperform since medical professionals become salaried government workers without adequate rewards for exceeding average standards. Government-driven health care poses at least three major threats to providers.<o:p></o:p>
<o:p> </o:p>
First: The practice of every aspect of government-monopolized medicine inevitably will be reduced to “cookie cutter” standards. Every health care provider knows that patients’ conditions are not exactly the same, and treatments must be tailored to unique needs. Health care excellence like this is only possible under a vibrant free market and not under “one-size-fits-all” regulations of government-controlled health care.<o:p></o:p>
<o:p> </o:p>
Second: The cost and price structure of nationalized medical services are controlled and distorted by price controls dictated by political demands for low rates of reimbursement. There is no lack of historical experience with price and wage controls and their harmful consequences. The principal result is shrinking supplies of price controlled human and material resources, and thus the necessity of managing the decline. In the health care field, shortages must be rationed by deciding who shall receive and who shall be denied life-saving medicines and essential services. Patients with the greatest needs and groups deemed less worthy of treatment are likely to be the first victims of bureaucratically determined health care rationing.<o:p></o:p>
<o:p> </o:p>
Third: Government-run health services build barriers to the most talented young men and women thinking of a medical career. At the very time when there is a growing need for more talented medical practitioners to care for aging boomers, young people with ability and skill will not take on the long years of education and incur substantial student loans just to become de facto government staffers whose type and place of practice and whose reimbursement rates are dictated by federal agencies.<o:p></o:p>
<o:p> </o:p>
These threats, if they become law, will prove lethal to <st1:country-region w:st="on"><st1:place w:st="on">America</st1:place></st1:country-region>’s health care providers. It means we will be on the path to socialized medicine. It is understandable that the Congressional Majority ridicules the claim that this is their objective, but the “public option” insurance plan which they propose as “an important tool to discipline insurance companies," in the recent words of the President, must lead step-by-step down that road. Mocking a fact does not make it untrue. And all we ask is that Democrats call their plan by its rightful name.<o:p></o:p>
<o:p> </o:p>
Health care providers, whether private insurers, doctors, hospitals, or trade associations must resist the temptation to “cut a deal” that would trade some benefit (some type of medical malpractice reform, for instance) in return for silence or outright support for the Majority’s proposal. That “deal” would only buy a little time after which the competitive health care market will be transformed into a nationalized monopoly under which every provider will lose its independence once government is the single payer for medical services.<o:p></o:p>
<o:p> </o:p>
Every day <st1:country-region w:st="on"><st1:place w:st="on">America</st1:place></st1:country-region>’s health care professionals meet the most critical medical needs of our people with a selfless dedication too often overlooked. They deserve our thanks. And they deserve our understanding that the excellence of care they provide cannot continue under a health care government monopoly. In the struggle between their right to practice and compete under free market democracy versus nationalized health service, <st1:country-region w:st="on"><st1:place w:st="on">America</st1:place></st1:country-region>’s dedicated health care providers must not stand to one side. Providers must engage in this struggle for the future of their high profession and commitment to the wellness of the American people.<o:p></o:p>
<o:p> </o:p>
VII. What Is Really At Stake In This Debate?<o:p></o:p>
European Social Welfare State or American Free Market Democracy<o:p></o:p>
<o:p> </o:p>
As important as this debate over the future of health care is, the ramifications go beyond simply health care. This debate may well prove to be a surrogate for the defining issue of our generation: The nature of democratic self-government and whether this great American experiment in individual freedom will be cast aside as inadequate to today’s concerns.<o:p></o:p>
<o:p> </o:p>
If this sounds hyperbolic, consider: <st1:country-region w:st="on"><st1:place w:st="on">America</st1:place></st1:country-region>’s private and public sector already spend about $2.5 trillion a year on health care, more than twice what any other country spends per person, amounting to some 17 percent of our nation’s GDP. If government is now to take over the whole cost burden as another entitlement, the transformation of our society into a European-style social welfare state will be unstoppable. This democratic system under which each citizen takes active responsibility for working to fulfill his or her potential, maturely judging risks and rewards, will be replaced by a nation of passive subjects grateful to government leaders for anything they receive to satisfy their needs, desires, and dreams.<o:p></o:p>
<o:p> </o:p>
The Democratic health care program is a means to a larger end. If President Obama and his party truly want “more competition,” as they say, why propose government insurance instead of enabling more non-profit insurance? If they have no intention of transforming the system into Medicare for all, why do they tie all payments to Medicare? If they have no design to ration health care, why did they tuck in the stimulus package’s fine print a new Institute for Comparative Effectiveness similar to <st1:country-region w:st="on">Britain</st1:country-region>’s National Institute for Health and Clinical Excellence (NICE), which interferes in health technology development in order to lower costs under <st1:country-region w:st="on"><st1:place w:st="on">Britain</st1:place></st1:country-region>’s nationalized health service? This Institute’s stated purpose is to identify medical practices that produce outcomes that “work” as opposed to those that “don’t work.” But under a national health care insurance plan, just as we see in Medicare even now, providers will not be paid out of the plan for health care which the Institute disapproves of. Once competing plans have been driven out of business, the result will be that the government’s approval or disapproval alone will dictate the care providers may offer to beneficiaries. Without any other resource for heath care payments, government decisions through the Institute about “what works” and “what does not work” will automatically result in denying procedures or treatments for certain categories of patients.<o:p></o:p>
<o:p> </o:p>
Finally, if the Majority is so worried about our skyrocketing national debt and the burden on the next generation, why do they want to create an entirely new entitlement that would deal a staggering blow to our economy – an entitlement that rivals the size and liabilities of Medicare?<o:p></o:p>
<o:p> </o:p>
Perhaps because this is ultimately not about health care but about advancing a larger, and I believe pernicious, ideological crusade. The nation that was founded on the belief that our unalienable rights were granted to us not by government but by “nature and nature’s God” will be remade into a “benevolent” social welfare state. Government-run health care is the first step down that path.<o:p></o:p>
<o:p> </o:p>
Compare the Canadian health care system, which liberals often point to as a model for the <st1:country-region w:st="on"><st1:place w:st="on">U.S.</st1:place></st1:country-region> The government is the single payer for health service, though most providers are in the private sector. In <st1:country-region w:st="on"><st1:place w:st="on">Canada</st1:place></st1:country-region> the waiting list is up to more than 4 months between patient referrals and actual treatment for a dozen of the specialty procedures most needed. The average Canadian now has to wait over a month after getting a primary doctor’s instruction just to get a CT scan, and more than two months for an MRI. <st1:country-region w:st="on"><st1:place w:st="on">Canada</st1:place></st1:country-region>’s medical equipment is old, unreliable, and obsolete. Canadians, famous and not so famous, travel to the <st1:country-region w:st="on"><st1:place w:st="on">U.S.</st1:place></st1:country-region> if they can for treatments for everything from cancers and emergency care to hip surgery and childbirth. <st1:country-region w:st="on">Canada</st1:country-region> has long suffered a professional “brain drain,” its doctors fleeing the government-run health care program to practice in the <st1:country-region w:st="on"><st1:place w:st="on">U.S.</st1:place></st1:country-region> The U.S. Government tried to make this more difficult, yet according to a 2007 report, one in nine doctors trained in <st1:country-region w:st="on"><st1:place w:st="on">Canada</st1:place></st1:country-region> is now practicing medicine here. But where will Americans, whether uncared-for patients or government medical workers, go to when the <st1:country-region w:st="on"><st1:place w:st="on">U.S.</st1:place></st1:country-region> also has socialized health care? There is no place of freedom left. Either we keep free market democracy here, or it will enter the history books as civilization’s great but unsuccessful experiment in human liberty.<o:p></o:p>
<o:p> </o:p>
It falls to Republicans to prevent that from happening. It rests with us to keep <st1:country-region w:st="on"><st1:place w:st="on">America</st1:place></st1:country-region> on the path of free markets, which has served us so well in the past, which has lifted countless people out of poverty, and which can lead Americans to a healthier and more prosperous future. This is the moment in which we need to step up and be counted, in which we fight for the principles on which this nation was founded and to which it must remain committed. The stakes could hardly be higher.<o:p></o:p>
<o:p> </o:p>
Our members should concentrate all of our attention on getting this message out to our constituents and the entire country, using all the means from speeches and letters to the many new media formats available to do this.<o:p></o:p>
<o:p> </o:p>
###<o:p></o:p>

To learn more about The Patients’ Choice Act of 2009: http://www.house.gov/ryan/PCA <o:p></o:p>
For the latest from Paul Ryan: http://twitter.com/reppaulryan |http://www.facebook.com/reppaulryan | http://www.youtube.com/reppaulryan | http://www.house.gov/ryan <o:p></o:p>

Not really
 

Honey Badger Don't Give A Shit
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Someone else needs to use the Quote feature on MMJ's last post so that it then takes a full 90 seconds to scroll down through five one-liner Replies.
 

There's no such thing as leftover crack
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My statements come from my perception that the republicans just want too block anything that was not written by insurance or AMA lobbyist.

I think there's an element of truth in that, but there are additional factors. I think one such factor is the Republicans are fearful that a successful plan that's seen as being implemented by Obama and the Democrats will result in the Republicans staying in the minority for years to come. I believe they'll do what's necessary to prevent that appearance. I think there's a great deal of misinformation being spread in the Republican talking points in an effort to derail the idea of changing the status quo and including a public option.

Also, there are several Democratic senators that are bought by these lobbyists and they are walking a tightrope. Their constituents are beginning to become aware of this and many will turn against them come election time. The reason they all take money from these lobbyists is that it costs millions for them to defend their Senate seats and get re-elected and this is where they get the dough from.

I have way too much to say on this, but have come to believe that there are too many posters that don't want a legitimate discussion (punter is not one of them), so I'll leave it a that.
 

Conservatives, Patriots & Huskies return to glory
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hehehehehe

you got the fearful part right :103631605

I'm fearful he's going to fuck up our health care on demand, diminish quality because health care professionals are simply not going to do more for less, reduce the rate of new developments by taking away investment incentives for pharmaceuticals, explode our deficit by creating a new and largest bureaucracy with the stroke of the pen (just imagine, health care run by the likes of social security employees, OMFG) and simply creating longer lines in America.

Good thing people will have more time on their hands to wait in those lines :think2:

I'm not fearful his plan (whatever) is going to work, that's silly. There's no chance in hell it can work. As in simply not possible
 

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Lines? My wife and I both took care of enrolling in medicare by phone. They ask if I wanted to start on SS at that time. I didn't but it would have been just that simple.

More republican disinformation?
 

Conservatives, Patriots & Huskies return to glory
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Lines? My wife and I both took care of enrolling in medicare by phone. They ask if I wanted to start on SS at that time. I didn't but it would have been just that simple.

More republican disinformation?

this one just doesn't have very much experience dealing with a government bureaucracy.

just observe an office for 10 minutes, then get back to be

of course, we might just have different standards :think2:
 

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My standards are that I prefer to make a phone appointment and take care of everything sitting at my desk with a drink. If you would prefer to just walk in and stand in line, I guess that's your thing.
 

Conservatives, Patriots & Huskies return to glory
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My standards are that I prefer to make a phone appointment and take care of everything sitting at my desk with a drink. If you would prefer to just walk in and stand in line, I guess that's your thing.


Obviously, you haven't helped many people solve their problems
 

Conservatives, Patriots & Huskies return to glory
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an accurate description of our government in action

THANKS TO experiences too numerous and painful to record, most Americans would agree with author Martha Derthick's assertion that "the institutions of American government function in ways that are not conducive to good administration." Her latest book documents and explains why that's truly the case. This is a revealing work about government for which the hackneyed expression, "Easier said than done" would be an appropriate subtitle.
<!-- google_ad_section_end (name=s1) --> <!-- google_ad_section_start (name=s2 weight=.3) --> In broad and theoretical terms under American democracy, the President and the Congress arrive at a consensus that becomes "law" and, hence, the "policy" of the government. Courts interpret the law while administrative bureaucracies carry it out. In reality, that high school textbook description doesn't do justice to the minefield that putting policy into practice has become. Presidents and Congresses give little thought to how their plans are to be implemented. Furthermore, they disagree, change their minds, and micromanage. Courts intervene and sometimes even make their own law. Bureaucracies get caught squarely in the middle. Derthick, a professor of government and foreign affairs at the University- of Virginia and former Brookings Institution senior fellow illustrates the argument by analyzing two highly publicized cases of poor administration by the Social Security Administration. The first case is that of SSI, the formerly state-run supplemental security income program, and the decision of Congress and the President to federalize it under SSA in 1974. The second case is that of an eligibility review for disability insurance recipients that Congress and the President ordered SSA to undertake in 1980.
These two events did irreparable damage to the image and integrity of SSA, once thought of as, in Derthick's language, "the Marine Corps of the domestic civil service - elite and invincible." Mention them to anyone in-the-know in Washington today, and you will elicit a wince and a shake of the head. They were first-rate disasters worthy of the sort of intense review provided here by Derthick.
When SSI was handed over to the SSA to administer, the agency was utterly unprepared. It had no experience in implementing a means-tested income support program. All it did before was dole out benefits to people who had earned the right to them by the relatively easy-to-verify process of paying taxes. Determining "need" was like nailing jello to the wall, especially when lead time to take over the program was inadequate and no less than 3 million impatient recipients from 1,350 state and local administrative units were knocking on the federal door.
A cascade of errors resulted: overpayments, underpayments, late payments, no payments at all, payments to ineligibles, to name a few. In all, $400 million was misspent in the first year.
The disability review was prompted by concern in Washington that the burgeoning rolls of disability recipients were being clogged by people who really were not eligible. Like a blind behemoth, SSA whacked away. Soon the press was documenting horror story after horror story until the spring of 1984, when "opposition was so powerful and the chaos was so complete that the Administration was compelled to suspend the review and wait for Congress to try to restore order with new legislation."
Bureaucracy was not the lone culprit. The Presidency was the source of plans "hastily conceived and born of the postelection urge to act," or the "victory syndrome" as Derthick terms it. It sought to rationalize, standardize and simplify policy but its "distance from the field" rendered much of its effort futile or even counterproductive. Its attempt at oversight pushed SSA to act at cross-purposes and in ways that destabilized the agency's pattern of relations with Congress, the courts, and the public.
Responding to its own mix of whim and pressure, an inconstant Congress overwhelmed SSA with directives and changes. Derthick paints the legislative branch as inherently Janus-faced: acting on the one hand as an institutional policymaker for the nation and as a body of 535 politicians, each with his own constituency, on the other. Much of its oversight consisted of casting blame on everybody else.
The courts contributed too. Derthick shows how they "significantly enlarged the administration burden" of SSI and in the case of the disability review, put SSA virtually in judicial receivership."
 

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My wife has. Going to court is a pain in the ass. Thats why you get to charge for it.

Dont know what you go through with SS, but with the IRS if you get a power of attorney you can do everything online.

Sorry if I'm wrecking your rant about dealing with govt offices.
 

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Wow Willie you should see our accountant. He dosent seem to have all the problems that you do.
 

powdered milkman
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i love how this thread is in blue
 

Officially Punching out Nov 25th
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i love how this thread is in blue

So it's not my browser...can we make it like this all the time or is it just for threads that are loaded with long winded partisan hackery...so I guess all of them
 

powdered milkman
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So it's not my browser...can we make it like this all the time or is it just for threads that are loaded with long winded partisan hackery...so I guess all of them
not sure but i will keep bumping it for aesthetics only
 

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against this old prick shows just how far his head is up his loony leftist ass.

clearly you don't know that Louie Gohmert has an alternative health plan, called a Health Savings Account, which is far less expensive and more inclusive than what we know about BHO's "plan". I would post you links to his plan but since you can't think for yourself, it would be useless to provide the info. Enjoy BHO's infomercial tonight! Dasvedanya

Haveing read Louie Gohmerts plan I would tell it in short like this:



A group of people get together and decide would be good for each of them to pay into a pool so that if any of them got sick or injured that it would be paid for.

They would elect one of them to govern the pool so that no one used the money for frivolous ends.

Well Louie say I have a better idea. He says "government is evil and the money should stay in our hands and we can get the treatment we want from who we want. My trophy wife needs a boob job and that cannot be done under govt guide lines. Furthermore if we dont use our money on our healthcare we get to invest it so that we might have it when we need it"

"What if someone gets sick and uses all of their money?" ask the others. "well part of the money should be used for insurance" said Louie.

"We all can't get insurance at an affordable rate you stupid cocksucker. Thats why we are proposing this healthcare program" Said the others.
 

Conservatives, Patriots & Huskies return to glory
Handicapper
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My wife has. Going to court is a pain in the ass. Thats why you get to charge for it.

Dont know what you go through with SS, but with the IRS if you get a power of attorney you can do everything online.

Sorry if I'm wrecking your rant about dealing with govt offices.


clueless

I can't even comprehend how one actually thinks all issues can simply be resolved "online". Too funny. I guess I have to add naivete to clueless, that ought to cover it.

my rant is a stone cold fact of reality, you obviously don't have the knowledge base to talk about this issue. No surprise really, par for the course.
 

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Well, if they keep making it easier and more user friendly who is going to need all you bean counters?
 

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